Abstract Introduction Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population. Methods Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed. Results sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year. Conclusion sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year.
Strained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain.Cross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management.658 HCW responded (33%; 95%CI, 32-36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as "a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill"; while some recommended defining "high-quality care", integrating "safety", and families in the definition. Participants reported significant contributors to strain were: "inability to discharge ICU patients due to lack of available ward beds" (97%); "increases in the volume" (89%); and "acuity and complexity of patients requiring ICU support" (88%). Strain was perceived to "increase stress levels in health care providers" (98%); and "burnout in health care providers" (96%). The highest ranked strategies were: "have more consistent and better goals-of-care conversations with patients/families outside of ICU" (95%); and "increase non-acute care beds" (92%).Strain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies "outside" of ICU settings were priorities for managing strain.
Abstract Background: Malnutrition is the most common nutritional disorder in developing countries and it remains one of the most common causes of morbidity and mortality among children worldwide. Childhood malnutrition is a multi-dimensional problem. An increase in household income is not sufficient to reduce childhood malnutrition if children are deprived of food security, education, access to water, sanitation and health services. However, due to regional variations in prevalence of acute malnutrition, it is important to explore the risk factors specific to the region, for designing and implementing public health interventions. Objective: To assess the prevalence and risk factors of malnutrition among children under five years Methods: A descriptive study enrolled 100 children under five years in Helat Hassan Health Centre, Wad-Medani, Gezira State during the period from November 2020 - March 2021. Data regarding children and families characteristics, nutritional history, health and medical history and anthropometric measurements were collected. Malnutrition was defined according to WHO guideline as -3SD of age specific BMI Results: Among 100 children, 59(59%) males and 41(41%) females, their mean age was 33±18 months. The frequency of malnutrition was 10% (n=10) and underweighting was 18% (n=18). Child's related risk factors associated with malnutrition were; children order above 4th (P. value= 0.000) and number of under 5 children in family above 3 children (P. value= 0.00). Family's related risk factors associated with malnutrition were; younger mother blow 30 years (P. value= 0.001), non-mother (relative) caregivers (P. value= 0.000), illiterate mothers (P. value= 0.046), employed mothers (P. value= 0.000), relative as income responsible (P. value= 0.009), lack of medical insurance (P. value= 0.047), lack of in-home source of water (P. value= 0.003), and low income blow 6,000 SDG (P. value= 0.000). Nutritional related risk factors associated with malnutrition were; lack of exclusive breastfeeding (P. value= 0.000), less than three meals per day (P. value= 0.021), lack of vegetables and fruits in daily nutrition (P. value= 0.006) and lack of milk and dietary products in daily nutrition (P. value= 0.000). Health related risk factors associated with malnutrition were; illness as cause of health care center visit (P. value= 0.018), anemia (P. value= 0.002), admission to hospital in last 2 months (P. value= 0.005), fever, cough, runny rose or chest infection in last 2 weeks (P. value= 0.032), chronic diarrhea (20.7%; P. value= 0.018) and history of malnutrition (P. value= 0.001). Conclusion: The frequency of malnutrition is not neglectable in Helat Hassan Health Centre at Wad-Medani. Malnutrition was found to be multi-factorial and associated with child, family, nutritional and health related factors. Effective, efficient and equitable program and intervention should be designed to reduce child malnutrition
BackgroundAcute kidney injury (AKI) is a serious complication following lung transplantation (LTx). We aimed to describe the incidence and outcomes associated with AKI following LTx.
ABSTRACT Objectives Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory injury with multiple physiological sequalae. Shunting of deoxygenated blood through intra and extra-pulmonary shunts is one consequence that may complicate ARDS management. Therefore, we conducted a systematic review to determine the prevalence of sonographically detected shunt and its association with oxygenation and mortality in patients with ARDS. Data Sources We searched MEDLINE, EMBASE, Cochrane Library and DARE databases on March 26, 2021 Study Selection Articles relating to respiratory failure and sonographic shunt detection. Data Extraction Articles were independently screened and extracted in duplicate. Data pertaining to study demographics and shunt detection were compiled for mortality and oxygenation outcomes. Risk of bias was appraised using the Joanna Briggs Institute and Newcastle-Ottawa Scale tools with evidence rating certainty using GRADE methodology. Data Synthesis From 4,617 citations, 10 observational studies met eligibility criteria. Sonographic detection of right-to-left shunt was present in 21.8% of patients (range:14.4-30.0%) amongst included studies using transthoracic, transesophageal and transcranial bubble Doppler sonography. Shunt prevalence may be associated with increased mortality (risk ratio: 1.22, 95% CI: 1.01-1.49, p=0.04, very low certainty evidence) with no difference in oxygenation as measured by P a O 2 :FiO 2 ratio (mean difference -0.7, 95% CI: -18.6 to 17.2, p=0.94, very low certainty evidence). Conclusions Intra- and extra-pulmonary shunts are detected frequently in ARDS with ultrasound techniques. Shunts may increase mortality amongst patients with ARDS, but its association with oxygenation is uncertain. Future research should explore the role of shunt in ARDS, their association with mortality, and whether targeted precision medicine interventions can improve outcomes. PROSPERO Registration Number: CRD42021245194 (March 26, 2021) Key Points Question: In adult critically ill ARDS patients, what is the prevalence of right-to-left shunts, and what are their effects on mortality and/or oxygenation? Findings: In this systematic review and meta-analysis, shunts be may prevalent in ∼1 in 5 ARDS patients. They may be associated with a statistically significant increase in mortality, with no difference in oxygenation parameters. Meaning: Intra- and extra-pulmonary shunts are detected frequently in ARDS with ultrasound techniques, and may increase mortality amongst patients with ARDS (although its association with oxygenation is uncertain).
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)